It is time to drop a discriminatory policy that bars gay men from donating blood in Canada, several leading HIV-AIDS researchers said in an article published last week in the Canadian Medical Association Journal.
But the organization that maintains the country's blood supply and a group representing hemophiliacs were quick to insist science hasn't yet evolved to the point where it's safe to take that step.
At the heart of the controversy is a policy that bars any man who has had sex with even one other man since 1977 from giving blood. That date was selected as it is believed to be before HIV began to circulate within the gay community, the demographic hardest hit by AIDS in the developed world.
In the words of Canadian Blood Services and Hema-Quebec, which maintain the country's two blood services, it is an "indefinite deferral." In the eyes of the gay and lesbian community, it is a ban - and discrimination.
"We're not asking for all gay men to be able to give blood. If someone's a gay man and promiscuous, we say, 'Exclude them.' We're trying to be balanced and moderate here," said lead author Dr. Mark Wainberg, head of AIDS research at Montreal's Jewish General Hospital and the McGill University AIDS Centre.
"The current policy is one that discriminates against all gay men in a permanent way and that seems a bit ... not only unfair, but it seems to be counter to the best interests of the blood agencies that chronically encounter shortages."
Wainberg and his co-authors suggested the policy, which dates back to a time when there was no effective way to screen donated blood for the HIV virus, should be modified to permit gay men in long-term, monogamous relationships to donate blood.
They suggested gay men should be asked to defer donating blood for a period of time after having sex with a new partner - perhaps a year, perhaps even as long as five years. They noted that women who have sex with bisexual men are asked to refrain from giving blood for a year.
Wainberg and his colleagues calculated the increased risk as small or virtually non-existent, depending on the length of the deferral.
But their argument met with immediate objection from the Canadian Hemophilia Society, a group whose members paid a heavy price for the earlier inability and then unwillingness to screen all blood donations for HIV and hepatitis C. About 1,200 Canadians were infected with HIV in the 1970s and early 1980s, more than half of them hemophiliacs.
"You have to remember, who bears the risk here? The risk is borne 100 per cent by the recipient," said David Page, national executive director of the Canadian Hemophilia Society.
"It's not borne by the donor, whether the donor decides to give blood or doesn't decide to give blood or feels hard done by because it's discriminatory - which it is. There's no doubt about that. The question is, does it go beyond what is necessary in terms of discrimination?"
The debate comes as the gay and lesbian community and Canadian Blood Services await the verdict in a trial that could have ramifications on the issue.
Kyle Freeman, a gay man from Thornhill, Ont., was sued last fall after he revealed he'd given blood despite the ban. Freeman countersued Canadian Blood Services, alleging their screening question violated his Charter rights.
The case was heard in Ontario Superior Court and a ruling is expected to be handed down in the near future.
Douglas Elliott, a lawyer who frequently represents the Canadian AIDS Society, dismissed as a "fallacy" the notion that the screening questionnaire used by Canadian Blood Services and Hema-Quebec keeps the blood supply free of HIV.
(It is in fact one step in a multi-step process designed to minimize the risk that Canadians will contract blood-borne pathogens through blood transfusions.)
"There is no test for gay blood. So this question is only as effective as the kind of co-operation that the Canadian Blood Services and Hema-Quebec get from the gay community. Historically they've had very good co-operation from us and that is what has protected the blood supply," Elliott said.
But he said perpetuating a ban that the gay and lesbian community believe is discrimination rooted in homophobia is eroding that co-operation.
"My mother taught me a long time ago: Ask a stupid question, get a stupid answer," Elliot said.
"The longer you ask a question that people find patently ridiculous, the more likely you are going to have people like Mr. Freeman who are going to simply ignore the question and do a self-assessment. That's not something that we encourage by any stretch, but that is a reality."
Elliott noted the American Red Cross looked at the issue and found that is already taking place. A study they conducted showed they had numerous gay blood donors who were ignoring the screening question "because they thought it was idiotic."
Ron Vezina, communications manager for Canadian Blood Services, said the agency regularly re-examines the issue of the ban to determine whether it is still justified by scientific evidence.
"We're open to changing the policy as long as the science and the evidence back it," Vezina said from Ottawa.
"This CMAJ paper is one good voice to keep that discussion going, but it is only one voice. And there is not medical consensus on this issue."
Vezina admitted the policy isn't perfect, but the system is designed to be as safe as it can be for recipients of blood products.